Chartbook on Healthy Living: Slide Presentation—Introduction

Slide 1

National Healthcare Quality and Disparities Report

Chartbook on Healthy Living
June 2015

Slide 2

Organization of the Chartbook on Healthy Living

• Part of a series related to the National Healthcare Quality and Disparities Report (QDR).
• Contents:
  • Overview of the QDR.
  • Overview of Healthy Living, one of the priorities of the National Quality Strategy.
  • Summary of trends and disparities in Healthy Living from the QDR.
  • Tracking of individual measures of Healthy Living:
    • Maternal and Child Health Care.
    • Lifestyle Modification.
    • Clinical Preventive Services.
    • Functional Status Preservation and Rehabilitation.
    • Supportive and Palliative Care.

Slide 3

National Healthcare Quality and Disparities Report

• Annual report to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129).
• Provides a comprehensive overview of:
  • Quality of health care received by the general U.S. population.
  • Disparities in care experienced by different racial, ethnic, and socioeconomic groups.
• Assesses the performance of our health system and identifies areas of strengths and weaknesses along three main axes:
  • Access to health care.
  • Quality of health care.
  • Priorities of the National Quality Strategy.

Note: This Healthy Living chartbook is part of a family of documents and tools that support the National Healthcare Quality and Disparities Report (QDR). The QDR includes annual reports to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). These reports provide a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial, ethnic, and socioeconomic groups. The purpose of the reports is to assess the performance of our health system and to identify areas of strengths and weaknesses in the health care system along three main axes: access to health care, quality of health care, and priorities of the National Quality Strategy.

Slide 4

National Healthcare Quality and Disparities Report

• Based on more than 250 measures of quality and disparities covering a broad array of health care services and settings.
• Data generally available through 2012.
• Produced with the help of an Interagency Work Group led by the Agency for Healthcare Research and Quality and submitted on behalf of the Secretary of Health and Human Services.

Note: The QDR is based on more than 250 measures of quality and disparities covering a broad array of health care services and settings. Data are generally available through 2012, although rates of uninsurance have been tracked through the first half of 2014. The QDR is produced with the help of an Interagency Work Group led by the Agency for Healthcare Research and Quality (AHRQ) and is submitted on behalf of the Secretary of Health and Human Services (HHS).

Slide 5

Changes for 2014

• New National Healthcare Quality and Disparities Report (QDR):
  • Integrates findings on health care quality and health care disparities into a single document to highlight the importance of examining quality and disparities together.
  • Focuses on summarizing information over the many measures that are tracked.

Note: Beginning with this 2014 report, findings on health care quality and health care disparities are integrated into a single document. This new National Healthcare Quality and Disparities Report highlights the importance of examining quality and disparities together to gain a complete picture of health care. This document is also shorter and focuses on summarizing information over the many measures that are tracked.

Slide 6

Key Findings of the 2014 QDR

• Demonstrates that the Nation has made clear progress in improving the health care delivery system to achieve the three aims of better care, smarter spending, and healthier people, but there is still more work to do, specifically to address disparities in care.
  • Access improved.
  • Quality improved for most National Quality Strategy priorities.
  • Few disparities were eliminated.
  • Many challenges in improving quality and reducing disparities remain.

Slide 7

2014 Chartbooks

• 2014 QDR supported by a series of related chartbooks that:
  • Present information on individual measures.
  • Are updated annually.
  • Are posted on the Web (https://archive.ahrq.gov/research/findings/nhqrdr/2014chartbooks/).
• Order and topics of chartbooks:
  • Access to care.
  • Priorities of the National Quality Strategy.
  • Access and quality of care for different priority populations.

Note: Information on individual measures will be available through chartbooks posted on the Web (https://archive.ahrq.gov/research/findings/nhqrdr/2014chartbooks/).

Slide 8

Chartbooks Organized Around Priorities of the National Quality Strategy

1. Making care safer by reducing harm caused in the delivery of care.
2. Ensuring that each person and family is engaged as partners in their care.
3. Promoting effective communication and coordination of care.
4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
5. Working with communities to promote wide use of best practices to enable healthy living.
6. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

Note: Healthy Living is one of the six national priorities identified by the National Quality Strategy (http://www.ahrq.gov/workingforquality/index.html).

Go to: National Quality Strategy Priority in Action: Boston Children's Hospital Community Asthma Initiative.

Slide 9

Priority 5: Working with communities to promote wide use of best practices to enable healthy living

Long-Term Goals:

1. Promote healthy living and well-being through community interventions that result in improvement of social, economic, and environmental factors.
2. Promote healthy living and well-being through interventions that result in adoption of the most important healthy lifestyle behaviors across the lifespan.
3. Promote healthy living and well-being through receipt of effective clinical preventive services across the lifespan in clinical and community settings.

Note: The broad goal of promoting better health is one that is shared across the country, whether it is promoting healthy behaviors, such as being tobacco free, or fostering healthy environments that make it easier to exercise and get access to healthy food. Successful efforts to improve these health factors rely on deploying evidence-based interventions through strong partnerships between local health care providers, public health professionals, and individuals.

Slide 10

Chartbook on Healthy Living

• This chartbook includes:
  • Summary of trends across measures of Healthy Living from the QDR.
  • Figures illustrating select measures of Healthy Living.
• Introduction and Methods contains information about methods used in the chartbook.
• Appendixes include information about measures and data.
• A Data Query tool (http://nhqrnet.ahrq.gov/inhqrdr/data/query) provides access to all data tables.

Slide 11

Summary of trends: Number and percentage of all quality measures that are improving, not changing, or worsening through 2012, overall and by NQS priority

Image: Chart shows summary of trends:

Key: n = number of measures.
Note: For the majority of measures, trend data are available from 2001-2002 to 2012.

• For each measure with at least four estimates over time, weighted log-linear regression is used to calculate average annual percentage change and to assess statistical significance. Measures are aligned so that positive change indicates improved access to care.
  • Improving = Rates of change are positive at 1% per year or greater and statistically significant.
  • No Change = Rate of change is less than 1% per year or not statistically significant.
  • Worsening = Rates of change are negative at -1% per year or greater and statistically significant.
• About half of Healthy Living measures improved compared with 60% of all quality measures.

Slide 12

Summary of trends: Average annual rates of change of quality of care measures through 2012, by National Quality Strategy priority

Image: Chart shows summary of trends with Healthy Living highlighted. Healthy Living measures show a slight improvement in quality.

Key: n = number of measures.
Note: Large red diamonds indicate median values. For each measure with at least four estimates over time, weighted log-linear regression is used to calculate average annual percentage change. Measures are aligned so that positive change indicates improved quality of care.

• Median change in quality was 1.1% per year among measures of Healthy Living.

Slide 13

Healthy Living Measures That Improved Quickly

• Four Healthy Living measures improved quickly, defined as an average annual rate of change greater than 10% per year:
  • Adolescents ages 16-17 years who received 1 or more doses of tetanus-diphtheria-acellular pertussis vaccine.
  • Adolescents ages 13-15 years who received 1 or more doses of tetanus-diphtheria-acellular pertussis vaccine.
  • Adolescents ages 16-17 years who received 1 or more doses of meningococcal conjugate vaccine.
  • Adolescents ages 13-15 years who received 1 or more doses of meningococcal conjugate vaccine.

Slide 14

Healthy Living Measures That Showed Worsening Quality

• Four Healthy Living measures showed worsening quality:
  • Maternal deaths per 100,000 live births.
  • Children ages 19-35 months who received 3 or more doses of Haemophilus influenzae type B vaccine.
  • Women ages 21-65 years who received a Pap smear in the last 3 years.
  • Women ages 50-74 years who received a mammogram in the last 2 years.

Slide 15

Healthy Living Measures With Elimination of Disparities

• Five Healthy Living measures showed elimination of disparities for different groups:
  • Children ages 19-35 months who received 1 or more doses of measles-mumps-rubella vaccine.
  • Adults age 65 years and over who received an influenza vaccination in the last 12 months.
  • Children ages 19-35 months who received 3 or more doses of hepatitis B vaccine.
  • Adults with obesity who ever received advice from a health professional about eating fewer high-fat foods.
  • Adolescent females ages 13-15 years who received 3 or more doses of human papillomavirus vaccine.

Slide 16

Healthy Living Measures With Widening of Disparities

• Two Healthy Living measures showed widening of Black-White disparities:
  • Adult current smokers with a checkup in the past year who received advice in the last 12 months to quit smoking.
  • Breast cancer diagnosed at advanced stage per 100,000 women age 40 years and over.

Slide 17

Measures of Healthy Living

• This chartbook tracks measures of Healthy Living through 2012 and 2013, overall and for populations defined by age, race, ethnicity, income, education, insurance, and number of chronic conditions.
• Measures of Healthy Living include:
  • Receipt of processes that reflect high-quality preventive and supportive care.
  • Outcomes related in part to receipt of high-quality preventive and supportive care.

Slide 18

Services That Promote Healthy Living

• Much valuable health care is delivered to prevent disease, disability, and discomfort rather than to treat specific clinical conditions.
• These services improve health and quality of life and are often better characterized by stage over a lifespan rather than by organ system.

Slide 19

Services Covered in This Chartbook

• This chartbook is organized around five types of health care services that support healthy living but typically cut across clinical conditions:
  • Maternal and Child Health Care.
  • Lifestyle Modification.
  • Clinical Preventive Services.
  • Functional Status Preservation and Rehabilitation.
  • Supportive and Palliative Care.